Provider Demographics
NPI:1265987861
Name:DEVILLIERS, DIANA
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:DEVILLIERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 BICKNELL AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2221
Mailing Address - Country:US
Mailing Address - Phone:310-467-5120
Mailing Address - Fax:
Practice Address - Street 1:138 BICKNELL AVE
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-2221
Practice Address - Country:US
Practice Address - Phone:310-467-5120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14692103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist